War zone Veteran cognitive-related functional decline and posttraumatic stress symptoms: Relationship to intimate partner stress

Abstract: Objective: Intimate partners of war zone veterans (WZVs) often report significant stress. WZV cognitive concerns and associated functional impairment may contribute to partner stress. WZV posttraumatic stress symptoms (PTSS) may also generate partner stress. Associations among WZV cognitive-related functional decline, PTSS, and partner stress, however, are not fully understood. This study examined associations of longitudinal change in WZV cognitive-related functioning with partner stress measured at a follow-up assessment, accounting for concurrent WZV PTSS. Method: 127 U.S. Iraq WZVs self-reported cognitive-related functioning prior to an index deployment using the Medical Outcomes Study, Cognitive Functioning scale (Stewart, Ware, et al., 1992). Over 8 years later (M = 8.8; SD = 1.7), WZVs were readministered the Medical Outcomes Study Cognitive Functioning and completed the Clinician-Administered PTSD Scale (Blake et al., 1995); intimate partners completed the Everyday Stressor Index (Hall, 1983). Results: Hierarchical regression analyses revealed a significant unadjusted association between longitudinal decline in WZV cognitive-related functioning and greater intimate partner stress. In analyses adjusted for PTSS cluster scores and WZV military status, WZV cognitive-related functional decline was no longer significantly associated with partner stress, whereas WZV hyperarousal symptoms were positively correlated with partner stress. Conclusions: Although WZV functional cognitive decline was associated with greater partner stress, this relationship appeared attributable to WZV hyperarousal symptoms. Findings suggest that partners of WZVs with elevated hyperarousal symptoms may require additional resources to help mitigate their stressors and that WZVs reporting worsened cognitive-related functioning may benefit from interventions targeting arousal and other PTSS in addition to interventions addressing cognitive concerns. Clinical Impact Statement Deployment to a war zone may adversely affect not only service members but also their intimate partners, with such effects enduring long after the service member has returned home. Partners often report increased stress because of challenges in day-to-day life the war zone veteran may be facing. Our findings suggest that war zone veteran arousal symptoms, such as heightened anger, sleep disturbance, and poor concentration, and relatedly, impairment in war zone veterans' daily activities secondary to changes in concentration and other thinking skills, may increase burden on intimate partners. Partners of war zone veterans experiencing such problems will benefit from additional support.